ABSTRACT
The aim of this study is to examine the life quality and exercise addiction behaviors of individuals working out in the gym and living in different countries. There were 319 volunteers going to the gym regularly that participated in this study. The mean age of participants was found to be 31.23±7.79. Of the participants, 48.9% were females and 51.1% of them were males. There were 40.1% of the participant reported married and 59.9% of them reported single. All the participants were Turkish but they live in different countries. The participants reported that they live in Turkey, Germany, Netherlands, Belgium, and Norway. The Exercise Dependence Scale, developed by Hausenblas and Downs (2002) (12), adapted to Turkish by Yeltepe (2005) (46), was used to find out exercise dependence behaviors in participants. A 36-Item Short Form Health Survey (SF-36), developed by Rand Corporation, adapted to Turkish by Koçyiğit et al (1999) (17), was used to determine life quality of the participants. Significant difference was found between genders in terms of physical function. Significant difference was found between participants according to countries where they were from in terms of physical functioning, role physical, role emotional, bodily pain, general health, withdrawal effects, continuance, tolerance, lack of control, reduction in other activities, time, and intention effects. Positive correlations were found between mental health and withdrawal effects, continuance, tolerance, lack of control, reduction in other activities, time, and intention effects. Negative correlations were found between withdrawal effects, continuance, lack of control, reduction in other activities, time, and intention effects. Negative correlation was found between social functioning and continuance. Negative correlations were found between general health and continuance, tolerance, and reduction in other activities. It was found that exercise addiction predicted physical functioning, mental health, physical pain, and general health. Consequently, it can be said that life quality and exercise addiction behaviors vary depending on the country that the participants are living in, gender, and marital status. The regression analysis revealed that exercise addiction predicted physical functioning, mental health, physical pain, and general health dimensions. It can be concluded that exercise addiction is a determinant of some dimensions of life quality.

Keywords: Exercise addiction, life quality, health, gender.

INTRODUCTION
Physical and psychological benefits of regular exercise are well known. Furthermore, it is an empirically proved fact that regular exercises have positive impacts on physical and mental development, and have important roles to prevent and treat physical impairment. It has been also proved that regular physical activity has positive effects on various chronicle diseases such as diabetes, cardiovascular diseases, and hypertension (44).

It is possible that exercise can become an obsession causing negative results, besides it is done voluntarily and fondly (6). While regular exercises provide many physical, emotional, and social benefits, excessive physical activity accompanies a type of addiction (19). In this point, it will be useful to define addiction. Addiction is defined as a behavioral process providing opportunities for getting rid of internal disturbance or having pleasure-inducing time (9). Kurimay et al. (18), in their study titled “Exercise Addiction: Dark Side of Sports and Exercise” and Berzczik et al. (4) stated that exercise addiction could be conceptualized as a behavioral addiction. Behavioral addiction is compeller psychological and physiological stimulation for specific or more behaviors (8).

Exercise addiction is defined as the desire to do physical activity severely, which causes psychological and physiological symptoms in individuals and results in habits of doing more exercise that become difficult to control (12). Indications such as anxiety, restlessness, feelings of guilt caused by not being able to exercise, tension, irritability, laziness, loss of appetite, insomnia, and headache can be seen in the constellation of exercise addiction (1). Macfarlane, Owens and Cruz (2016) proposed a three-dimensional exercise addiction model including learned/cognitive component (negative perfectionism), behavioral component (obsessive-compulsive drive) and hedonic component (Self-worth compensation and reduction of negative affect and withdrawal) (26).

In literature, studies have examined the exercise addiction in terms of eating disorders (24, 28, 16, 34, 33), personality traits (24, 29), life quality (24), attachment styles (24), alexithymia (27), leptin level (23), gender (41), social environment (41) and exercise behavior parameters (47).
Exercise addiction studies have been conducted by participation of athletes in team and individuals sports (30) such as football (25) and bodybuilders (25, 28) while they have also been conducted by the participation of unlicensed individuals running regularly (43).

Kaur, Agarwal, and Bhatia (2009), in their study in which they examined causes, signs and symptoms, concurrent diseases, and measuring methods of exercise addiction, stated that this type of addiction was specifically seen in women at the ages between 35-60 years. In the same study, physical symptoms of exercise addiction was classified as tiredness, pain, stiffness, hormonal changes and it was stated that these had negative impacts on ligaments, tendons, bones, cartilage and joints. Increasing anxiety, disturbance in resting and inability to stop exercise were showed as behavioral symptoms (15). Some studies have showed that exercise addiction is relatively common. For example, Lejoyeux et al. classified 42% of clients in a French sport center and 30% of clients in a French fitness center as exercise addicted (20, 21).

It is possible that duration, intensity, and frequency of exercise can be out of the personal control besides its positive effects. Beyond making exercise a part of life, individuals organize their lives and all activities according to exercise routine at the cost of reducing time spent with family and friends, social and spare time activities (46). Griffiths (1997) revealed that exercise addicted individuals had conflict between exercise and daily life (10). In this point, it can be inferred that having conflicts between doing exercise and participating daily life activities may affect life quality. Life quality is related to individuals feeling well and looking healthy. Health related life quality, additional to having no diseases, involves being physically, socially, culturally, and psychologically active, feeling well, and life satisfaction (36).

The aim of this study is to reveal how exercise addiction predicts life quality, examine life quality, and exercise addiction of Turkish individuals who were raised in different cultures and doing regular exercises by providing better understanding for exercise addiction.

Hypothesis

Exercise addiction predicts physical functioning.

Exercise addiction predicts mental health.

Exercise addiction predicts pain.

Exercise addiction predicts perceived general health.

There are no significant differences between genders in terms of exercise addiction.

There are no significant differences between genders in terms of life quality.

There are no significant differences between individuals according to the country they were raised in terms of exercise addiction.

There are no significant differences between individuals according to the country they were raised in terms of life quality.

Assumption
It was assumed that all of the participants responded to the items objectively.

Limitations

The study is limited with the measurement strength of the exercise dependence scale and a 36-Item Short Form Health Survey (SF-36) scale.

The study is limited to the 319 volunteers doing regular exercise in a fitness center in Turkey, Germany, Netherlands, Belgium, and Norway.

METHODSResearch Model
A descriptive survey model has been adopted in this study. The descriptive survey model is a research approach aiming to determine a condition existing in the past or present (14).

Population and Sample
There were 319 volunteers doing regular exercise in fitness centers that participated in the study. The age mean of participants was found to be 31.23 ± 7.79. Of the participants, 48.9% were female and 51.1% of them were male. Participants responded to their educational level as primary (1.6%), secondary (10.7%), high school (48.9%), graduated (30.7%), and master (8.2%). The study group consisted of Turks living in Turkey (29.5%), Germany (27.9%), Netherlands (14.1%), Belgium (16.0%), and Norway (12.5%). The study group was chosen from different European countries because it was aimed to find out whether any cultural differences exist.

Data Collection Tool
There are different approaches to measure exercise addiction in literature (38, 35, 32, 39, 12, 32, 42). Griffiths et al. (2015) (11) also made cross-cultural evaluation of exercise addiction inventory (42). In this study an Exercise Dependence Scale, developed by Hausenblas and Down (2002) (12), adapted to Turkish by Yeltepe (2005) (46), was used. To measure life quality, SF-36, developed by Rand Corporation, adapted to Turkish by Kocyigit et al. (1999) (17), was used. Cronbach’s alpha value of Exercise Dependence Scale was found to be .88 in this study.

Data Collection
The data was collected by one of the researchers going to Germany, Netherlands, Belgium, and Norway. Before starting data collection researchers collected the data participants in Turkey.

Data Analysis
Data was analyzed in the Statistical Package for the Social Science (SPSS) by using linear regression, Pearson Correlation, one-way ANOVA and Independent t test.

RESULTS
In this section, regression analysis results are presented of four hypothesized models, correlations, differences between genders, single and married participants, and individuals according to the country they were raised in.

Table 1. Exercise addiction as a predictor of physical functioning

β

t

p

R2

Adjusted R2

F

p

Regression Coefficient

41.066

7.693

.000

.041

.038

13.658

.000

Exercise Addiction

5.662

3.696

.000

Predictor: (Constant), Exercise Addiction

Dependent Variable: Physical Functioning
Regression analysis showing that exercise addiction predicted physical functioning was given in Table 1. It was found that exercise addiction predicted physical functioning by 4.1% (R2=.041). The hypothesized model was found to be statistically significant (F=13.658, p=0.000). Positive correlation was found between exercise addiction and physical functioning (r=0.203) and this result was found to be statistically significant (t=7.693, p=0.000).

Table 2. Exercise addiction as a predictor of mental health

β

t

p

R2

Adjusted R2

F

p

Regression Coefficient

35.035

13.841

.000

.070

.067

23.628

.000

Exercise Addiction

3.531

4.861

.000

Predictor: (Constant), Exercise Addiction

Dependent Variable: Mental Health
Regression analysis showing that exercise addiction predicted mental health was given in Table 2. It was found that exercise addiction predicted mental health by 7.0% (R2=.07). The hypothesized model was found to be statistically significant (F=23.628, p=0.000). Positive correlation was found between exercise addiction and mental health (r=0.264) and this result was found to be statistically significant (t=13.841, p=0.000).

Table 3. Exercise addiction as a predictor of pain

β

t

p

R2

Adjusted R2

F

p

Regression Coefficient

86.570

13.131

.000

.091

.088

31.845

.000

Exercise Addiction

-10.679

-5.643

.000

Predictor: (Constant), Exercise Addiction

Dependent Variable: Pain
Regression analysis showing that exercise addiction predicted pain was given in Table 3. It was found that exercise addiction predicted pain by 9.1% (R2=.091). The hypothesized model was found to be statistically significant (F=31.845, p=0.000). Negative correlation was found between exercise addiction and pain (r=-0.302) and this result was found to be statistically significant (t=13.131, p=0.000).

Table 4. Exercise addiction as a predictor of perceived general health

β

t

p

R2

Adjusted R2

F

p

Regression Coefficient

55.871

20.053

.000

.021

.018

6.764

.000

Exercise Addiction

-2.079

-2.601

.000

Predictor: (Constant), Exercise Addiction

Dependent Variable: Perceived General Health
Regression analysis showing that exercise addiction predicted perceived general health was given in Table 4. It was found that exercise addiction predicted perceived general health by 2.1% (R2=.021). The hypothesized model was found to be statistically significant (F=6.764, p=0.00). Negative correlation was found between perceived general health and exercise addiction (r= -0.145) and this result was found to be statistically significant (t=20.053, p=0.000).

Table 5. Differences between genders in terms of exercise addiction and life quality

Variable

Female

Male

n

X

SD

n

X

SD

t

p

FF

156

62.83

16.58

163

58.31

15.19

2.537

.012*

RF

156

24.35

12.91

163

25.30

14.29

-.620

.535

RE

156

24.03

14.32

163

24.64

14.26

-.377

.706

VIT

156

50.22

10.15

163

52.08

8.92

-1.730

.085

MH

156

47.25

8.16

163

47.08

7.27

.196

.845

PA

156

50.46

20.04

163

49.30

20.64

.507

.613

SF

156

49.35

19.3

163

49.07

19.02

.130

.897

PGH

156

47.24

8.54

163

50.14

7.73

-3.181

.002*

WDE

156

3.37

.67

163

3.37

.64

.080

.936

CON

156

3.38

.76

163

3.51

.79

-1.495

.136

TOL

156

3.31

.69

163

3.39

.70

-1.108

.269

LC

156

3.41

.80

163

3.43

.81

-.255

.799

ROA

156

3.38

.78

163

3.42

.78

-.466

.641

TM

156

3.54

.70

163

3.54

.70

-.013

.989

IE

156

3.48

.74

163

3.50

.69

-.198

.844

Note: See Table 7 for the acronym key.

Significant difference was found between genders in terms of Physical Functioning. Female participants reported higher scores them males (p<0.05, t=2.537). Significant difference was found between genders in terms of General Health Perception (p<0.05, t=-3.181) No significant differences were found between genders in terms of other dimensions.

Table 6. Differences between marital statuses in terms of exercise addiction and life quality

Variable

Married

Single

n

X

SD

n

X

SD

t

p

FF

128

56.03

16.77

191

63.53

14.79

-4.205

.012*

RF

128

22.65

13.56

191

26.30

13.50

-2.363

.019*

RE

128

24.08

14.30

191

24.52

14.28

-.264

.792

VIT

128

52.00

9.26

191

50.63

9.75

1.252

.212

MH

128

47.77

8.61

191

46.76

7.04

1.150

.251

PA

128

51.69

20.73

191

48.65

20.01

1.314

.190

SF

128

47.75

19.99

191

50.19

18.51

-1.118

.264

PGH

128

49.17

6.92

191

48.41

9.05

.807

.420

WDE

128

3.31

.71

191

3.41

.62

-1.228

.220

CON

128

3.38

.88

191

3.49

.70

-1.225

.221

TOL

128

3.28

.75

191

3.40

.65

-1.407

.160

LC

128

3.37

.83

191

3.46

.79

-.929

.353

ROA

128

3.34

.91

191

3.43

.68

-.977

.329

TM

128

3.52

.79

191

3.56

.64

-.445

.657

IE

128

3.41

.81

191

3.54

.64

-1.607

.109

Differences between marital statuses in terms of exercise addiction and life quality have been displayed in Table 6. Statistically significant differences were found between single and married individuals in terms of physical functioning (p<0.05, t=-4.205) and role physical (p<0.05, t=-2.363) dimensions. It was observed that single individuals reported higher scores than married ones in terms of physical functioning and role physical dimensions. No significant differences were seen in other dimensions.

Correlation analyses of exercise addiction and life quality have been displayed in Table 7. Positive correlations were found between physical functioning and withdrawal effects (r=.224, p<0.05), continuance (r=.210, p<0.05), lack of control (r=.178, p<0.05), and reductions in other activities (r=.189, p<0.05), time (r=.189, p<0.05). Negative correlation was found between role emotional and lack of control (r=-111, p<0.05). Negative correlation was found between vitality and lack of control (r= -.163, p<0.05). Positive correlations were found between mental health and withdrawal effects(r=.200, p<0.05), continuance(r=.222, p<0.05), tolerance (r=.268, p<0.05), lack of control (r=.212, p<0.05), reduction in other activities (r=.128, p<0.05), time (r=.205, p<0.05), and intention effects (r=.213, p<0.05).

Negative correlations were found between withdrawal effects(r=-.211, p<0.05), continuance(r=-.345, p<0.05), lack of control (r=-.274, p<0.05), reduction in other activities (r=-.307, p<0.05), time (r=-.240, p<0.05), and intention effects (r=-.177, p<0.05). Negative correlation was found between social functioning and continuance(r=-.143, p<0.05). Negative correlations were found between general health and continuance(r=-.113, p<0.05), tolerance (r=-.116, p<0.05), and reduction in other activities (r=-.136, p<0.05).

Table 8. Differences between participants according to country in terms of exercise addiction and life quality

Differences between participants according to country in terms of exercise addiction and life quality have been displayed in Table 8. Significant differences were found between participants according to country in terms of the subscales of FF (F=7.725, p<0.05), RF (F=3.406, p<0.05), PA (F=5.941, p<0.05), PGH (F=7.554, p<0.05), WDE (F=2.947, p<0.05), CON (F=5.180, p<0.05), TOL (F=5.590, p<0.05), LC (F=6.833, p<0.05), ROA (F=6.895, p<0.05), TM (F=10.911, p<0.05) and IE (F=8.893, p<0.05). In Physical Functioning, while it was found that participants living in Turkey reported higher scores than those living in Norway, analyses showed that individuals living in Germany reported higher scores than those living in Belgium and Norway. In this subscale, it was observed that individuals doing regular exercise and living in the Netherlands reported higher scores than those living in Belgium.

In Role Physical subscale, analyses revealed that individuals living in Norway had lower scores than those living in Turkey, Germany, and Belgium while participants living in Norway showed higher scores than those living in Turkey, Germany, and Netherlands in terms of Pain subscale. Participants living in Belgium also reported higher scores than those living in Turkey and Germany with regards to Perceived General Health subscale.

Individuals living in Norway and doing regular exercise reported lower scores than those living in Turkey, Germany, and Netherlands with regard to Withdrawal Effects, Continuance and Tolerance. These individuals also reported lower scores than those living in Belgium in this dimension. In the subscale of Lack of Control, it was found that people living in Turkey had higher scores than those living in Belgium and Norway while individuals living in Germany reported higher scores than those living in Norway. The analyses applied in the dimension of Reduction in Other Activities revealed that participants living in Norway had lower scores than those living in Turkey, Germany, and Netherlands and people living in Netherlands had higher scores than those living in Belgium. It was found that people living in Norway displayed lower scores than Turkey, Germany, Belgium, and Netherlands in terms of Time and Intention Effects.

DISCUSSION
The aim of this study was set as revealing how exercise addiction predicts life quality, examining life quality, and exercise addiction of Turkish individuals raised in different cultures and doing regular exercises by providing better understanding for exercise addiction.

There are four different regression models hypothesized in this study. In the first model, it has been proposed that exercise addiction predicts physical functioning, which is one of the subscales of life quality. It was found that exercise addiction predicts physical functioning by 4.1% (R2=0.041). The hypothesized model was found to be statistically significant (F=13.658, p=0.000). Positive correlation was found between exercise addiction and physical functioning (r=0.203) and this result was statistically significant (t=7.693, p=0.000).

It has been hypothesized that exercise addiction predicts mental health in the second model. The hypothesis was accepted because it was found that exercise addiction predicted mental health by 7.0% (R2=0.070). This model was also found to be statistically significant (F=23.628, p=0.000). Positive correlation was found between exercise addiction and mental health (r=0.264) and this result was statistically significant (t=13.841, p=0.000).

In the third regression model, it was found that exercise addiction predicted pain by 9.1% (R2=0.091). The hypothesized model was found to be statistically significant (F=31.845, p=0.000). Negative correlation was observed between exercise addiction and pain (r=-0.302) and this result was significant (t=13.131, p=0.000).

In the last regression model, it has been hypothesized that exercise addiction predicts perceived general health. Analysis revealed that exercise addiction predicted perceived general health by 2.1% (R2=0.021). The model was found to be statistically significant (F=6.764, p=0.000). Negative correlation was found between exercise addiction and perceived general health (r=-0.145), and this result was significant (t=20.053, p=0.000). All analyses have revealed that exercise addiction increases participants’ perceptions of physical functioning and mental health while it relatively decreases the pain perception and perceived general health.

Although Lichtenstein et al. (2015) revealed that there were no significant differences between addicted and non-addicted individuals in terms of life quality and stated that life quality of all participants were at a good level (23), Lichtenstein et al. (2014a) found that exercise addicted individuals reported lower scores than non-addicted ones in terms of pain in the study that they conducted with the participation of addicted and non-addicted individuals (24). In the present study, it can be seen that exercise addiction predicts pain and there is negative correlation between exercise addiction and pain. With this result, it can be inferred that exercise addictive individuals feel that the more they exercise the less they feel pain. When the first, second, and third models are examined, it can be said that exercise addiction creates a positive life quality perception on individuals, however the result of the last model does not support this inference because general health perception is relatively decreased by exercise addiction. This contradiction may stem from the perception that exercise addictive individuals think that more exercise has benefits on physical functioning, pain and mental health being unaware of the detrimental aspects of it and the result of the last model may have revealed that excessive exercise actually reduces perceived general health. Findings of Kaur, Agarwal and Bhatia (2009) are contrary to our results and inference because they stated that exercise addictive behaviors restrained normal living functions, however the result of our study showed that exercise addiction increased the physical function perception (15). Lichtenstein et al. (2014a) assumed that exercise addictive individuals would not have reduction in their life quality unless they disrupt their exercise routine (24). This assumption supports our findings that exercise addiction increases mental health perception. Furthermore, Mond et al. (2008) stated that exercise addiction might negatively affect health-related life quality (31). Bavlı et al. (2011) found that addictive individuals showed statistical differences according to exercise year, weekly exercise frequency, and daily exercise when compared to non-addictive groups (3).

Lichtenstein and Jensen (2016) found that exercise addiction was more common among young women and men under 30 years old (22). Pugh and Hadjistavropoulos (2011) observed that health perception components positively correlated with exercise desire and exercise addiction (37). These relations show that individuals giving importance to their physical appearance desire to do exercise and they generally do exercise for a long time to achieve the same effect again when exercise duration decreases and withdrawal symptoms occur.

Exercise addiction was correlated with some emotional and psychological factors in literature. Aidman and Woollard (2003) revealed that individuals running regularly showed emotionally and physiologically negative symptoms to a certain degree when they disrupted their exercise schedules (2). Divine et al. (2016) found that physical appearance and motivational climate (emotion and appearance) had positive impacts on exercise addiction symptoms (7). Hill et al. (2015) suggested that perfectionism related to one’s self was an important characteristics in terms of exercise addiction symptoms (13).

In a case study, Griffiths (1997) examined the exercise addiction in terms of salience, euphoria, tolerance, withdrawal symptoms, conflict, relapse, and loss of control, revealed that activities exercise addicted individuals participated in became dominating on their lives, thoughts, and behaviors, they felt robust only after doing exercise for a long time, exercise endurance increased as long as addiction increased, they displayed withdrawal symptoms when they became distanced from exercise, had confliction between exercise and daily life, failed to compose themselves while feeling exercise drive, felt anxious when they became distanced from or lack of exercise, felt better only after doing exercise (10).

CONCLUSION
It was found that exercise addiction predicted physical functioning, mental health, pain, and general health. Thus, hypothesis 1, hypothesis 2, hypothesis 3, and hypothesis 4 were accepted. No significant differences were found between genders in terms of exercise addiction. With these findings, hypothesis 5 was accepted. Significant differences were found between genders in terms of physical functioning and perceived general health. With this result, hypothesis 6 was rejected. Significant differences were found between individuals according to country grew in terms of exercise addiction and life quality, and hypothesis 7 and hypothesis 8 were rejected.

Consequently, it can be said that exercise addiction can create a feeling on addictive individuals that the more they do exercise the less they feel pain and the more they achieve benefits. For precautions to this type of addiction, differences between addiction and commitment should be explained. Warner and Griffiths (2006) revealed that individuals committed to exercise had logical, functional and psychological reasons for doing exercise while individuals at the risk of addiction gave the reason forcing them to excessive and dangerous exercise in their daily lives (45).

Diagnosis of this type of addiction is as important as distinguishing commitment and addiction. Cox and Orford (2004) concluded that individuals structured their program in this way and reveal exercise addiction a problem when exercise addiction was used as a diagnosis category (5). It can be said that distinguishing and diagnosing will help prevent exercise addiction.

For the prevention of exercise addiction, people studying sport or having background such as sport scientists, coaches, sport managers, physical educators, and sports teachers have critical roles. Awareness for exercise addiction can be created in faculty of sport sciences with lectures like sport psychology. Mass media, state institutions and organizations are also important for consciousness-raising and prevention. Berczik et al. (2012) suggested that media, health, and educational organizations should emphasize beneficial aspects of exercise (4).

It is important to indicate that it is not appropriate to suggest treatments for exercise addiction in this study because treatment is a medical issue and practitioners should suggest treatment for this type of addiction. However, suggestions can be added for prevention.

RECOMMENDATION

Exercise addiction studies should be the course subject in institutions giving education in sport sciences.

Seminars for informing athletes, coaches and sport managers about the detrimental aspects of exercise should be organized.

This study is limited with Turks raised in Turkey, Germany, Netherlands, Norway, and Belgium. People from different countries can be added in future studies.

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Abstract

The notion of paying college football players has been an ongoing debate since the early 1900’s. With current television revenue resulting from NCAA football bowl games and March Madness in basketball, there is now a clamoring for compensating both football and basketball players beyond that of an athletic scholarship. This article takes a point/counterpoint approach to the topic of paying athletes and may have potential implications/consequences for college administrators, athletes, and coaches. Dr. John Acquaviva defends the current system in which colleges provide an athletic scholarship that provides a “free college education” in return for playing on the university team. Dr. Dennis Johnson follows with a counterpoint making the case that athletes in these sports should receive compensation beyond that of a college scholarship and forwards five proposals to pay the athletes.

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The coaching profession is ever-changing and coaches at each level of sport competition need to know more than just the Xs and Os in order to be successful. As the primary individuals tasked with developing athletes and helping them achieve their goals, coaches should acquire a working knowledge of all areas affiliated with performance enhancement. Specifically, the disciplines of sports administration, sports medicine, strength and conditioning, and sports psychology can assist coaches while physically and mentally training their athletes. This article illustrates six primary components of these disciplines: risk management, injury prevention, communication, nutrition, goal setting, and athlete development. It is imperative coaches gain a familiarity with these aforementioned components in order to teach athletes about skill development and prepare them to achieve peak performance.